﻿@using WebApp.Extensions

@Html.Scripts(
    @<script type="text/javascript">
        require(['Auth/_Register'], function (api) {
            $(function () { api.exec(); });
        });
    </script>)

<div class="featured-box featured-box-secundary default info-content">
    <div class="box-content">
        <h4>Register An Account</h4>
        <form action="#" id="register-form" data-bind="submit: register">
            <div class="row">
                <div class="col-md-6">
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="code">Code</label>
                                <input id="code" type="text" value="" class="form-control" data-bind="value : code" required>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="name">Name</label>
                                <input id="name" type="text" value="" class="form-control" data-bind="value : name" required>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="DOB">Date of Birth</label>
                                <input id="DOB" type="text" value="" class="form-control" data-bind="datepicker : dateOfBirth,  datepickerOptions : { format: 'MM/DD/YYYY' }">
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="address">Address</label>
                                <input type="text" id="address" value="" class="form-control" data-bind="value : address" required>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="email">E-mail</label>
                                <input id="email" type="text" value="" class="form-control" data-bind="value : emailaddress" required>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="form-group">
                            <div class="col-md-12">
                                <label for="mobile">Mobile</label>
                                <input type="text" id="mobile" value="" class="form-control" data-bind="value: mobilenumber" required>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="row">
                    <div class="col-md-12">
                        <input type="submit" value="Register" class="btn btn-primary pull-right push-bottom" data-loading-text="Loading...">
                    </div>
                </div>
            </div>
        </form>
    </div>
</div>